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Follicular Cyst

Clinical Features of Follicular Cyst The name is based on location. The cyst is keratin filled, skin colored, and firm. It appears as a singl,e sessile nodule which is freely movable.
Microscopic Features of Follicular Cyst Epidermoid has stratified squamous epithelium (SSE) containing a granular layer, filled with concentric layers of lamellated keratin. Pilar has an abrupt transition from SSE to the lumen filled with compact keratin; no granular layer.
Differential Diagnosis of Follicular Cyst Epidermoid Cyst, Pilar Cyst, Sebaceous Cyst. Having cheesy, foul-smelling keratinous content in the cyst and present during excision/drainage is diagnostic for Epidermoid Cyst.
Treatment of Follicular Cyst Surgical Excision is the treatment and submission of tissue for a definitive diagnosis is required. Excellent prognosis with no cancerous transformation is observed.
Demographics of Follicular Cyst The most common follicular cyst is the epidermoid cyst (80%) with it being most common in acne prone areas of HN and back. The Pilar Cyst (10-15%) is more common on the scalp (90% with 2F:1M. It is solitary in 30% of cases and multiple in 70% of cases.
Epidermic (Infundibulum) Cyst It is a skin colored, dome-shaped nodule (0.5-5cm) from the infundibulum of a hair follicle, located in the dermis. It is firm, but malleable; semi-solid content. Multiple epidermoid cysts is a feature of Gardner's Syndrome.
Pilar Cyst It is most commonly found on the scalp (90%), is hereditary, smooth, mobile, and filled w/ keratin in the hair, nails, skin, and horns. It is derived from the outer root sheath of the follicle with an unknown etiology. It rarely forms tricholemmal tumors.
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